An investigation of the risk factors associated with falls in people with Multiple Sclerosis

Study summary

This study aimed to evaluate the factors associated with increased falls risk in people with Multiple Sclerosis. Falls are a significant issue for people with Multiple Sclerosis; with research demonstrating more than 50 per cent of people falling in any six-month period. This study addressed gaps, currently identified in the literature, as to the relative contribution of the factors associated with falls in this patient group.

The study ran from April 2011- 2012. A total of 150 individuals (confirmed MS diagnosis, Expanded Disability Status Scale (EDSS) 3.5–6.5) were recruited, with 148 participants included in the final analysis. Demographic data were collected and performance assessed in eight predictor measures (Physiological Profile Assessment (PPA), Brief Ataxia Rating scale, Ashworth scale (Ashworth), Modified Falls Efficacy scale, Symbol Digit Modalities Test, dual-task interference, lying/standing blood pressure, static/dynamic visual acuity). Participants prospectively recorded falls over three months using a daily diary. People were classified as “fallers” based on reports of ≥ two falls.

Results

A total of 104 participants recorded 672 falls; 78 (52.7 per cent) reported ≥ two falls. Continence issues, previous falls history and use of prescribed medications were each associated with increased risk of being a “faller”. Ashworth and PPA risk score contributed significantly to a logistic regression model predicting faller/non-faller classification. The reduced model (Ashworth, PPA, EDSS) showed fair-to-good predictive ability (ROC c-statistic 0.73, sensitivity 70 per cent, specificity 69 per cent).

This study confirmed the high prevalence of falls in ambulant people with MS. Important potentially modifiable risk factors are identified, suggesting aspects to target in falls interventions.

Funding

PhD fees sponsored by the School of Allied Health, Faculty of Health, University of Plymouth. 

Grant applications

Chartered Society of Physiotherapy, Physiotherapy Research Foundation (£19980) 

Poster presentations related to this project:

1. Gunn, H., Freeman, J., Marsden, J. F., Haas, B., Creanor, S., & Zaijeck, J. (2012). Risk factors associated with falls in multiple sclerosis. Plymouth Hospitals Trust Annual Research Conference, Plymouth, UK

Conference presentations related to this project:

1. Gunn, H., Freeman, J., Marsden, J. F., Haas, B., Creanor, S., & Zaijeck, J. (2012). Risk factors associated with falls in multiple sclerosis. RIMS Oral Sessions: Platform communications. Multiple Sclerosis Journal, 18(5), S15–S24.

2. Gunn, H., Creanor, S., Haas, B., Marsden, J. F., & Freeman, J. (2013). Risk factors for falls in Multiple Sclerosis: challenges and opportunities. Indian Association of Physiotherapists Annual Conference, Goa, India

3. Gunn, H., Creanor, S., Haas, B., Marsden, J. F., & Freeman, J. (2013). Risk factors for falls in Multiple Sclerosis: challenges and opportunities. ACPIN annual conference (invited presentation), Northampton, UK

4. Gunn H, Nilsagard Y, Cameron M, Hoang P, Mazumder R, Freeman J, Lord S (2013). Falls in people with multiple sclerosis: an international perspective. ECTRIMS platform session, Copenhagen, Denmark

Publications related to this project:

1. Gunn H, Freeman J. Repeated Falls: A key outcome or an adverse event? Physiotherapy Research International 17(1):1-3 Mar 2012

2. Gunn HJ, Newell P, Haas B, Marsden JF, Freeman JA. Identification of Risk Factors for Falls in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Phys Ther. American Physical Therapy Association; 2013 Dec 13;93(4):504–13.

3. Gunn H, Creanor S, Haas B, Marsden JF, Freeman J. Risk factors for falls in Multiple Sclerosis: an Observational Study. Mult Scler. 2013;19(14):1913–22.

4. Gunn H, Creanor S, Haas B, Marsden J, Freeman J. Frequency, characteristics and consequences of falls in multiple sclerosis: findings from a cohort study. Arch Phys Med Rehabil. 2014;95(2):538–45.

5. Nilsagard Y, Gunn H, Freeman J, Hoang P, Lord S, Mazumder R, Cameron M. Falls in people with MS-an individual data meta-analysis from studies from Australia, Sweden, United Kingdom and the United States. MULTIPLE SCLEROSIS JOURNAL 21(1):92-100 Jan 2015.

6. Gunn H, Cattaneo D, Finlayson M, Freeman J. Home or Away? Choosing a Setting for a Falls-Prevention Program for People with Multiple Sclerosis. International Journal of MS Care 16(4):186-191, Dec 2014.

7. Coote S, Sosnoff JJ, Gunn H. Fall Incidence as the Primary Outcome in MS Fall Prevention Trials: Recommendations from the International MS Fall Prevention Research Network. International Journal of MS Care 16(4):178-184 Dec 2014.

8. Hoang PD, Baysan M, Gunn H, Cameron M, Freeman J, Nitz J, et al. 2016. Fall risk in people with MS: A Physiological Profile Assessment study. Mult Scler J - Exp Transl Clin. 2(0)